History of Psychiatry: Madness,Science,Culture

After World War II in the Netherlands, outpatient mental health care for children expanded greatly. The number of Child Guidance Clinics grew, and university child-psychiatric clinics and Youth Psychiatric Services were newly established. The leading diagnostic and treatment ideology was mainly Freudian and focused on psychotherapy. During the 1960s the Child Guidance Clinics were outstripped by the more innovative university clinics that introduced new kinds of treatment, such as play- and group-therapy. This ended the hegemony of psychiatrists, as child psychologists and psychiatric social workers replaced them as therapists. At the same time, psychologists of the two denominational university Paedological Institutes took the lead in the scientific study of children’s more serious psychopathology and the development of play-therapy and remedial teaching methods.

The first third of the twentieth century changed the therapeutical landscape with the emergence of new treatments for the mentally ill in asylums. However, the historiography of their use in Spanish psychiatric establishments has been scarcely studied. The popularization of barbiturate sleep therapies, insulin shock, cardiazol therapy, electroshock and leucotomy spread from the beginning of the century. However, the Spanish Civil War and Spain’s isolation during Franco’s autarky (1939–52) made their implementation difficult. Through historiographic research using medical records as documentary sources, this work analyses the socio-demographic conditions of the asylum population during the first decade of Franco’s dictatorship. The treatments used in Leganés Mental Asylum are described and are compared with those used in other Spanish psychiatric institutions.

In England in the early twentieth century, mental observation wards in workhouses developed as a parallel service to the asylums for emergency mental health admissions under the 1890 Lunacy Act, particularly in urban areas and especially London on account of local policy. The purpose of the wards was initial patient assessment and early discharge or certification, and there was controversy between their medical supporters and the Board of Control about any extension of their remit which might usurp the role of the mental hospitals. Their significance declined with changing policy in the NHS era, as more emergency admissions went to mental hospitals, and local treatment units emerged. This article explores the history of these services in the context of the changing legal and policy frameworks.

Older people had high admission rates to hospitals for the insane in New South Wales, Australia, in the second half of the nineteenth century. The medical casebooks of 226 patients aged 60 years and over admitted to two hospitals for the insane between 1849 and 1905 were examined. Aggressive behaviour (35.4%), suicidal behaviour (23.9%), fears of harm to self (19.9%) and alcohol issues (13.7%) were identified. Physical health factors (35.8%), functional impairment (18.6%) and poor nourishment (8.8%) were noted. Common diagnoses were mania (36.7%), dementia (31.9%) and melancholia (17.7%). Twenty-first-century diagnoses were assigned in nearly 94 per cent of cases with concordance that varied by diagnosis. The majority of admissions had serious mental disorders, with only 29.6 per cent being discharged.

Yawning is a fascinating physiological behaviour that has been poorly addressed except in old medical books. Whereas the purpose of this behaviour is still not clearly identified, the ancient authors made it a clinical symptom, especially a psychological one. After presenting some current notions about yawning, we review publications on yawning written by physicians, from antiquity to the twentieth century, and, in particular, those dealing with psychological and psychiatric aspects.

My book, published in 2020, reconstructs the history of ʿAṣfūriyyeh, one of the first ‘modern’ mental hospitals in the Middle East. It uses the rise and fall of this institution as a lens through which to examine the development of modern psychiatric theory and practice in the region as well as the socio-political history of modern Lebanon. ʿAṣfūriyyeh becomes a window into social-policy questions relating to dependency and welfare, definitions of deviance, the relation of mission to empire, state-building processes, and the relation of medical authority to religion. The book also examines the impact of war on health and healthcare infrastructures. Reflecting on the afterlife of this and other institutions, the book calls for a new ‘ethics of memory.’

Involuntary hospitalization has been a fundamental function of psychiatric care for mentally ill persons in the USA for centuries. Procedural and judicial practices of inpatient psychiatric treatment and civil commitment in the USA have served as a by-product of socio-political pressures that demanded constant reform throughout history. The origin of modern commitment laws can best be understood through the lens of cultural paradigms that led to their creation and these suggest caution for future legislative amendments.

In his book Observations on the Zoonomia of Erasmus Darwin MD, Thomas Brown included a critical chapter on the analysis of madness proposed by Darwin in Zoonomia. Although neither Darwin nor Brown are ground-breaking in their views on madness, they illustrate the transitional accounts of madness that were being entertained at the end of the eighteenth century, particularly among writers who had studied at Edinburgh University.